Misty Mountain Getaway - 6 October to 14 October 2007

- Registration Form -

Please print and return to:
• Postage Misty Threads, 40 Hickory St, Dorrigo, NSW 2453
• Phone (02) 6657 1200
• Fax (02) 6657 1300
• Email mistythreads@dorrigo.com
• Website www.dorrigo.com/mistythreads
Name: ......................................................................................................................................
Address: ......................................................................................................................................
City: ......................................................................................................................................
State: ..................................................... Postcode: ............................................................
Telephone: (..........) ........................................ Fax: (..........) ...............................................
E-Mail: ......................................................................................................................................
Date Workshop Selected Workshop Fee Kit Ordered Kit Fee
Sat 6 Oct        
Sun 7 Oct        
Mon 8 Oct        
Tue 9 Oct        
         
Thur 11 Oct        
Fri 12 Oct        
Sat 13 Oct        
Sun 14 Oct        
         
Optional Activities Welcome Dinner Misty’s
Sat- 6 Oct - $40		   Farewell Dinner Fresh
Saturday 13 Oct - $40
  
      Registration Fee
10.00
  Sub-Total
   Sub-Total  
     
Total  
  
Payment Method: (please tick)
[   ] Cheque or Money Order or Cash (made payable to Misty Threads) or
[   ] Credit Card    [   ] Bankcard  [   ] MasterCard  [   ] Visa  
Cardholder’s Name (as it appears on card): __________________________   
No:   
                               
Expiry Date:
       
(ccv) ---    
Amount Paying  $ _____________________________________________
Cardholder’s Signature: ________________________________________